Atypical diabetes in children: ketosis-prone type 2 diabetes

Department of Paediatrics, Bradford Royal Infirmary, Bradford, West Yorkshire, UK

Correspondence to Dr Atul Vaibhav, atulvaibhav{at}hotmail.com

Summary

Ketosis-prone type 2 diabetes mellitus also known as atypical or flatbush diabetes is being increasingly recognised worldwide.
These patients are typically obese, middle-aged men with a strong family history of type 2 diabetes. The aetiology and pathophysiological
mechanism is still unclear but some initial research suggests that patients with ketosis-prone type 2 diabetes have a unique
predisposition to glucose desensitisation. These patients have negative autoantibodies typically associated with type 1 diabetes
but have shown to have human leucocyte antigen (HLA) positivity. At initial presentation, there is an impairment of both insulin
secretion and action. β Cell function and insulin sensitivity can be markedly improved by initiating aggressive diabetes management
to allow for discontinuation of insulin therapy within a few months of treatment. These patients can be maintained on oral
hypoglycaemic agents and insulin therapy can be safely discontinued after few months depending on their β cell function.